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Oklahoma rates for HCPCS A5057

Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.99 / $7.99 / $7.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.99
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.05 / $8.05 / $8.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.80 / $11.75 / $11.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $9.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.99 / $8.39 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $6.40 / $13.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.69 / $8.77